Cardiac Assessment and Pulsus Paradoxus

Study Notes

Use a normal cuff at the distal malleoli to assess blood flow in posterior tibial or dorsalis pedis arteries.
A suspected vascular issue arises when leg systolic BP is lower than arm BP, particularly if the femoral pulse is delayed relative to the radial pulse.
Rule out cardiac tamponade when observing low arterial BP with a rapid and feeble pulse.
Pulsus paradoxus indicates an exaggerated drop in systolic pressure during inhalation, typically more than a normal 5 mm Hg.
To measure pulsus paradoxus, listen for BP sounds at expiration and continue deflation until sounds are noted during inspiration; a difference greater than 10 mm Hg is abnormal.

Cardiac tamponade results from increased intra-pericardial pressure, impacting diastolic filling.
An abnormal paradoxical pulse can also be present in larger pericardial effusions and constrictive pericarditis.

Measure cardiac rate by palpating the radial pulse; avoid using the thumb to prevent self-counting.
Count the pulse for 30 seconds and multiply by 2 for BPM; this is effective for regular rhythms.
Irregular rhythms are assessed for pulse deficit, especially in atrial fibrillation, where apical and radial pulses differ.

JVP measurement involves assessing height of neck veins from the manubriosternal angle.
Estimated pressure includes the height measured plus a standard 5 cm to the heart; significant elevations may indicate heart failure.

To check right ventricular function, apply pressure over the liver to observe transient changes in jugular vein distention.
Continuous distention during pressure indicates increased central blood volume and potential heart failure.

Diastolic murmurs, such as those from mitral and tricuspid stenosis, exhibit specific patterns including pauses between heart sounds and characteristics like decrescendo and low pitch.
Best heard in the left lateral decubitus position; presystolic accentuation occurs with atrial contraction.

PVD primarily affects men over 50; major causes include atherosclerosis, diabetes, and hypertension.
Classic symptoms involve leg pain or discomfort during exercise, numbness, and coolness in extremities.
Severe cases can cause rest pain, non-healing sores, and skin changes.

AAA is defined as a focal dilation of the aorta greater than 50% its normal diameter, commonly above the renal arteries.
Risk factors include advanced age, male sex, and atherosclerosis.
A ruptured AAA is often the first symptom, with significant mortality risk associated with size.

Diabetic patients face a high incidence of foot ulcers, often leading to serious complications.
The "Rule of 15" indicates that 15% may develop ulcers leading to osteomyelitis or amputations.
The "Rule of 50" shows that 50% of amputations are limb-sparing and 50% of patients may have another amputation within 5 years.

Venous stasis can lead to chronic insufficiency, causing complications like pigmentation and ulceration.
Evaluate capillary refill time by applying pressure to the nail bed; normal refill is less than 2 seconds.

Methods include spokes of a wheel, concentric circles, or vertical strip patterns for thorough palpation.
Describe masses based on size, position, shape, consistency, and mobility; benign masses are typically mobile, while malignancies are usually fixed.